Department of Surgery, Ospedale Card. G. Panico, Via Pio X 4, 73039, Tricase, Italy.
Department of Research, Research Institute against Digestive Cancer (IRCAD), 1, Place de l'Hôpital, 67091, Strasbourg, France.
Surg Endosc. 2023 Sep;37(9):7370-7375. doi: 10.1007/s00464-023-10316-2. Epub 2023 Aug 2.
Remarkable progress has been made in pancreatic surgery over the last decades with the introduction of minimally invasive techniques. Minimally invasive pancreatoduodenectomy (MIPD) remains one of the most challenging operations in abdominal surgery and it is performed in a few centers worldwide. The treatment of the pancreatic stump is a crucial step of this operation; however, the best strategy to perform pancreatic anastomosis is still debated. In this article, we describe the technical details of our original technique of modified minimally invasive end-to-end invaginated pancreaticojejunostomy (EIPJ) using video footage.
In the current study, we retrospectively analyzed a pilot series of 67 consecutive cases of minimally invasive (7 robotic/60 fully laparoscopic) MIPD operated on at the General Surgery Department of the Panico Hospital, Tricase (Italy) between March 2017 and October 2022.The reconstruction phase involved an EIPJ, tailored using an intra-ductal anastomotic plastic stent. The aim of this study was to describe the technique and evaluate the short-term outcomes of patients undergoing MIPD with EIPJ.
The mean operative time to perform the EIPJ was 21.57 ± 3.32 min. Seven patients (10.5%) developed biochemical leaks and 13 (19.4%) developed clinically relevant pancreatic fistulas (grade B or C according to the definition of the International Study Group on Pancreatic Surgery).
The early results confirm that this anastomosis is safe, easy to perform, and effective in the hands of hepatobiliopancreatic (HBP) surgeons with experience in minimally invasive surgery.
过去几十年，随着微创技术的引入，胰腺外科取得了显著进展。微创胰十二指肠切除术（MIPD）仍然是腹部外科中最具挑战性的手术之一，目前仅在全球少数中心开展。胰腺残端的处理是该手术的关键步骤；然而，行胰腺吻合的最佳策略仍存在争议。本文通过视频资料详细介绍了我们改良的微创端-端套入式胰肠吻合术（EIPJ）的技术细节。
本研究回顾性分析了 2017 年 3 月至 2022 年 10 月期间在帕尼科医院普外科行微创（7 例机器人辅助/60 例完全腹腔镜）MIPD 的 67 例连续病例的初步系列。重建阶段采用了 EIPJ，采用腔内吻合塑料支架进行个体化设计。本研究旨在描述该技术并评估行 EIPJ 的 MIPD 患者的短期结局。
行 EIPJ 的平均手术时间为 21.57±3.32 分钟。7 例（10.5%）患者发生生化漏，13 例（19.4%）患者发生临床相关的胰瘘（根据国际胰腺外科学研究组的定义为 B 级或 C 级）。
早期结果证实，对于具有微创外科经验的肝胆胰外科医生来说，这种吻合术安全、易于操作且有效。
